Ismee Williams is an Assistant Professor in the Division of Pediatric Cardiology at Columbia University with a long-term goal to become an independent clinical investigator of perinatal contributors to neurodevelopmental outcomes in the congenital heart disease (CHD) population. Dr. Williams' short-term goal is to acquire the skill set and experience needed to launch her career. To date, Dr. Williams has benefitted greatly from the clinical research environment of Columbia University which includes the resources made available by the NIH-funded Clinical and Translational Science Award (CTSA). Dr. Williams trained in the conduct of patient oriented research and received a Masters in Biostatistics from the Mailman School of Public Health during the last two years of her fellowship. Dr. Williams was named a K12 TRANSFORM scholar during her first year as an attending and received a $50,000 CTSA sponsored pilot award the following year. Over the past year, Dr. Williams has directed a multidisciplinary feasibility study that is the basis for the proposed protocol to investigate potential risk factors associated with neurocognitive outcomes in patients with complex CHD. The proposed study is innovative in its intent to investigate perinatal markers of risk. Using a prospective observational cohort design, Dr. Williams will enroll 50 fetuses with CHD and 25 normal controls in order to 1) further characterize autonomic regulation in CHD fetuses, 2) test associations between fetal autonomic regulation and fetal cerebral blood flow, and 3) test associations between these two fetal measures and infant and toddler neurologic outcomes including autonomic regulation, cerebral function measured by high-density EEG, and neurodevelopment assessed by the Bayley Scale of Infant Development-III at 18-months. The career development plan includes a closely mentored program under the supervision of Dr. William Fifer, a developmental psychobiologist, with focused training in perinatal autonomic assessment. In addition, Dr. Philip Grieve will train Dr. Williams in the procedure of infant high-density EEG assessment. Increased understanding of these topics will allow Dr. Williams to become a more effective clinical perinatal investigator of neurodevelopmental outcomes in CHD. PUBLIC HEALTH RELEVANCE: This study is important as: 1) CHD is the most common group of birth defects, 2) survival following CHD surgery is increasing, and 3) survivors of complex CHD often (>50%) have neurologic difficulties, including learning delay and mental retardation the causes of which are largely unknown. Identification of early markers of adverse neurologic outcomes will allow the implementation of timely preventative and therapeutic services.